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Intrathoracic extravasation of sclerosing agents associated with central venous catheters
J Watterson1, M Heisel, J A Cich
1Children's Hospital of Saint Paul, Department of Hematology/Oncology, MN 55105.
Insights
Continuous vesicant chemotherapy via central venous catheters (CVCs) in children can lead to serious complications like venous thrombosis and extravasation. Discontinuing chemotherapy and removing CVCs improved patient outcomes.
Area of Science:
- Pediatric Oncology
- Vascular Access Devices
- Chemotherapy Administration
Background:
- Central venous catheters (CVCs) are crucial for delivering long-term chemotherapy in pediatric patients.
- Vesicant chemotherapy agents pose risks of tissue damage if extravasation occurs.
- Continuous infusions may alter the risk profile for CVC-related complications.
Observation:
- Two pediatric patients receiving continuous vesicant chemotherapy via CVCs experienced venous thrombosis.
- One patient developed thoracic venous obstruction, respiratory distress, and pulmonary infiltrates during vincristine infusion.
- The second patient experienced superior vena cava thrombosis and retrograde extravasation during doxorubicin infusion.
Findings:
- Continuous infusions of vesicant chemotherapy through CVCs are associated with a risk of venous thrombosis and extravasation in children.
- Symptoms included thoracic venous obstruction, respiratory distress, pleural effusions, and pulmonary infiltrates.
- Both patients improved clinically after cessation of chemotherapy and removal of the CVCs.
Implications:
- Careful consideration of CVC placement and infusion strategies is necessary for vesicant chemotherapy in pediatric oncology.
- Continuous infusions of vesicant agents may necessitate enhanced monitoring for thrombotic and extravasation events.
- Alternative administration methods or closer surveillance may be warranted to mitigate these risks.
Abstract:
Two children receiving continuous infusions of vesicant chemotherapy through central venous catheters (CVCs) developed venous thrombosis, and intrathoracic extravasations ensued. One child receiving a continuous vincristine infusion presented with signs of thoracic venous obstruction, fever, and respiratory distress and had pleural effusions and pulmonary infiltrates on his chest roentgenogram. The other child was receiving a continuous doxorubicin infusion and developed superior vena cava thrombosis and retrograde extravasation along the catheter tunnel site. Both children improved after chemotherapy was discontinued and the CVCs removed. Catheter placement and the continuous infusion of sclerosing agents are discussed.